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Self-Esteem.
By Matthew McKay and Patrick Fanning. Oakland, CA: New Harbinger Publications, 2000, 316 pp., $15.95.
Self-Esteem, written by Matthew McKay and Patrick Fanning, is a comprehensive program that outlines a number of cognitive-behavioral techniques for the reader to incorporate into his or her recovery from problems with low self-esteem. The book is well-structured and organized in a logical fashion, with the first chapter devoted to a discussion of the make-up of self-esteem followed by a brief summary of how each successive chapter in the book deals with a particular aspect of self-esteem. McKay and Fanning describe self-esteem as “the ability to form an identity and then attach a value to it” (p. 1). They point out that there is an inherent drive in human beings to judge things, accepting and rejecting them based on a variety of conceived attributes and preconceived ideas. This, the authors argue, is where the danger of low self-esteem lies. When individuals begin judging and rejecting parts of themselves as flawed or inherently bad, poor self-esteem is likely to follow.
The book approaches its subject matter by using psychologist Eugene Sagan’s model of a “Pathological Critic” that exists in the minds of those who have low self-esteem. McKay and Fanning describe the Pathological Critic as “the negative inner voice that attacks and judges” (p.15) the person who is afflicted. This critic uses a variety of weapons to attack the individual’s self-esteem, including cognitive distortions, irrational thoughts, “shoulds”, and clouding of the individual’s ability to self-assess accurately. Self-Esteem includes a separate chapter for each of the weapons in the pathological critic’s arsenal, along with a variety of cognitive and behavioral techniques that can be employed by the reader to confront and stop the critic. McKay and Fanning incorporate an effective war analogy throughout their book, referring to the struggle of the reader as a “battle”. The “enemy” is the critic, who uses its “weapons” to deflate the individual’s self-esteem. The program “arms” the reader with techniques such as thought stopping, visualization, as well as guidance on forming accurate self-assessments and realistic goals and values. This figurative conflict is outlined in eleven succeeding chapters.
Within this framework of combating thoughts that lead to poor self-esteem, McKay and Fanning integrate information that will allow the healing process to take place and for positive self-esteem to begin to take root. Through detailed descriptions of techniques such as visualization and hypnosis for self-acceptance, the authors attempt to empower their readers with the knowledge and skills they need to maintain their self-esteem once the pathological critic has been overcome and their self-esteem has been improved. Teaching the readers to perform these techniques enables them to continue to maintain and improve their overall self-esteem. These issues are covered in the final three chapters, along with a chapter for parents who would like to instill more positive self-esteem into their children’s lives and a chapter that deals with the specific self-esteem issues that victims of abuse and drug addicts must face.
This book has a number of strengths that help to make it an excellent choice for bibliotherapy. First, Self-Esteem is written by a clinical psychologist who has been in private practice for thirteen years. Dr. McKay’s experiences as a psychotherapist working with patients who have suffered from self-esteem problems make this book both empathic and knowledgeable for the patient/reader. It seems almost as though Dr. McKay is able to read minds as he quotes some common “pathological critic” statements and describes the hopelessness and despair commonly experienced by those with poor self-esteem. Additionally, because Dr. McKay writes the book from the vantage point of a particular theoretical orientation, it will mesh well with a cognitive psychotherapist’s other techniques.
Another significant strength of this book is the scope with which the program attacks low self-esteem and seeks to maintain high self-esteem. The program literally starts from the very beginning with the simplest of concepts, and spans the entire experience with the reader, to the sections that help the patient maintain higher self-esteem once it has been achieved. This allows the book to be functional throughout the therapeutic process, and long after many of the patient/reader’s core issues have been addressed. There are cognitive-behavioral techniques in every chapter that are meant to address specific problems and difficulties that the patient/reader may face. Patients are encouraged to focus on the specific sections that most accurately address their problems, thus allowing the reader to “customize” his or her experience. As a result, this book could be assigned to the patient at the onset of therapy, or much later, after significant progress is made.
While the length and depth of this book can be considered strengths, (the book totals 316 pages and sixteen chapters) these may be weaknesses if the reader has difficulty with attention and focus, or if the reader is not especially motivated or doesn’t enjoy reading. Additionally, Self-Esteem is at times complex; the book may be best suited for those with a high school or college reading level. Some of the sections dealing with cognitive-behavioral self-help techniques read much like a textbook and could be difficult for patient/readers with less developed reading comprehension skills. In this particular case, the psychotherapist and patient would need to enter into a dialogue regularly to ensure that the book was sufficiently understood by the reader.
Perhaps the most effective way of incorporating Self-Esteem into a therapeutic program would be to assign the book chapter by chapter, as the patient appears ready to tackle another significant issue or problem with his/her self-esteem. It may be logical to skip chapters; some chapters and some issues will probably not apply to all patients. As mentioned earlier, it is important that the psychotherapist and the patient have a continuous and open dialogue concerning what is being discussed in the book. Because the cognitive and behavioral techniques outlined by McKay and Fanning are probably familiar to most cognitive-behavioral psychotherapists, practitioners will be able to provide additional guidance and instruction as needed.
Because the book is organized in a progressive fashion, patients will first have the opportunity to examine their pathological critic and identify the different types of negative self-statements that seem to be the most prevalent and damaging. Armed with this information, the psychotherapist and patient can begin their trek through the different steps involved with eliminating the self-defeating pathological critic and increasing self-esteem. Disarming the critic through the use of though stopping techniques will be an important goal early on in the therapeutic process. Meanwhile, the psychotherapist can assist the patient in discovering why these negative statements were adopted in the first place, and what their initial purpose was. McKay and Fanning stress the importance of uncovering the “secondary gain” behind these statements in order to put an end to the negative statements altogether. After this is accomplished, the psychotherapist and patient can move through subsequent chapters at their own pace, skipping those that are less relevant and emphasizing those with a particularly applicable message.
A special feature included in Self-Esteem is the numerous exercises that are included in each chapter. These exercises allow readers to apply what is being read to their own personal situations. The exercises are good tools for introspection and may also provide insight to the psychotherapist if openly discussed during sessions. Completing the exercises and going through them, step-by-step, with the psychotherapist could provide the patient with two valuable exercises in self-reflection.
This book is recommended to cognitive-behavioral psychotherapists (or practitioners of other theoretical orientations who can understand and appreciate the application of cognitive-behavioral techniques) who are treating adult patients that seem to be suffering from the pathological critic discussed in this book. More specifically, this book seems appropriate for those patients who are intelligent, have good reading comprehension skills, and are highly motivated to undertake an intensive and comprehensive program for increasing self-esteem. Patients who are not yet ready for change, do not enjoy reading, or that do not seem to be suffering from low self-esteem as a result of the pathological critic may not gain as much from this book.